Tuberculous abscess

Case contributed by Dr Ernest Lekgabe

Presentation

4/52 of falls and dizziness. Background of HTN, hypercholesterolaemia and previous traumatic brain injury. Neurologically intact on examination.

Patient Data

Age: 80 years
Gender: Male
CT

CT Brain

Multilobulated ring enhancing lesion in the posterior medial right frontal lobe. Marked surrounding vasogenic oedema. Bifrontal areas of encephalomalacia in keeping with previous traumatic brain injury.

 

MRI

MRI Brain

Multilobulated ring enhancing lesion in the posterior medial right frontal lobe with marked surrounding vasogenic oedema. Mild central restricted diffusion. The dural venous sinuses are patent. Bilateral frontal encephalomalacia in keeping with previous traumatic brain injury.

Pathology

Histopathology: The sections show a cerebral abscess. The contents comprise necrotic inflammatory debris. This is delimited by a layer of inflamed vascular granulation tissue. There is an encompassing mantle of oedematous and gliotic brain parenchyma in which there are multiple foci of active cerebritis. There is no evidence of tumour. Numerous acid fast bacilli with beaded morphology are identified in a Ziehl-Neelsen stained section. 

DIAGNOSIS: Tuberculous cerebral abscess.

Case Discussion

In the brain, tuberculosis can cause tuberculous meningitis, tuberculomas or tuberculous abscess. Tuberculous abscess has a capsule containing pus and acid fast bacilli. It is similar to a pyogenic abscess. Tuberculomas, on the other hand, do not contain pus, however, they may contain necrotic material. Tuberculomas are usually an extension of meningitis and are usually multiple, while tuberculous abscess is usually solitary.

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Case information

rID: 54744
Case created: 26th Jul 2017
Last edited: 1st Aug 2017
Inclusion in quiz mode: Included

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